Contraceptives and Breastfeeding

Changes to Guidelines for Contraceptive Use Could Compromise a Woman's
Ability to Breastfeed

New
Rochelle, NY, June 24, 2010 - New birth control guidelines released
by the U.S. Centers for Disease Control and Prevention (CDC) could undermine
mothers who want to breastfeed by sanctioning the use of progesterone
injections, progestin-only pills, as well as combined (progestin-estrogen)
oral contraceptives within the first month after giving birth.

“The new guidelines ignore basic facts about how breastfeeding works,"
says Dr. Gerald Calnen, President of the Academy of Breastfeeding Medicine
(ABM). "Mothers start making milk due to the natural fall in progesterone
after birth. An injection of artificial progesterone could completely derail
this process.”

The CDC report, “U.S. Medical Eligibility Criteria for Contraceptive Use,
2010,” released in the May 28 issue of Morbidity & Mortality Weekly Report (MMWR),
contains important changes in what constitutes acceptable contraceptive use by
breastfeeding women. The criteria advise that by 1 month postpartum the
benefits of progesterone contraception (in the form of progestin-only pills,
depot medroxyprogesterone acetate (DPMA) injection, or implants), as well as
the use of combined (progestin-estrogen) oral contraceptives outweigh the
risk of reducing breastfeeding rates. Previously, progesterone birth control was not
recommended for nursing mothers until at least 6 weeks after giving birth, and
combined hormonal methods were not recommended before 6 months.

Based on clinical experience, breastfeeding support providers report a
negative impact on breastfeeding when contraceptive methods are introduced too
early. One preliminary study demonstrated dramatically lower breastfeeding
rates at 6 months among mothers who underwent early insertion of progesterone-containing
IUDs, compared with breastfeeding rates of mothers who underwent insertion at
6-8 weeks postpartum.

“The data are limited,” says Calnen, “but for now, the state of the science
suggests that early progesterone exposure undermines breastfeeding.”

Family planning specialists argue that early hormonal birth control is needed
to reduce unplanned pregnancies. However, the most commonly used early
contraceptive method, a DPMA injection, prevents pregnancy for only 12 weeks at
a time. “There is no evidence that immediate postpartum injections delay the
next pregnancy beyond the first 3 months,” says Calnen.

Dr. Miriam Labbok, Director of the Carolina Global Breastfeeding Institute and
an expert on the interface between breastfeeding and fertility, notes, “The
mother should have the final decision on her birth control method, with full
information. Unfortunately, these methods are often given to women with little
counseling. Women deserve to know that there is a potential risk.”

ABM wrote to CDC Director Thomas Frieden in January urging reconsideration of
the guidelines. In his reply, Dr. Frieden described the new recommendations as
“the best interpretation of the existing evidence.”

Calnen is less confident. “Physicians and mothers should proceed with
caution," he says. "There are plenty of birth control methods that
are proven to be safe for breastfeeding. Early progesterone is not one of
them.”

The Academy
of Breastfeeding Medicineis a global organization of
physicians dedicated to the promotion, protection and support of breastfeeding
and human lactation through education, research, and advocacy. An
independent, self-sustaining, international physician organization and the only
organization of its kind, ABM 's mission is to unite members of various medical
specialties through physician education, expansion of knowledge in
breastfeeding science and human lactation, facilitation of optimal
breastfeeding practices, and encouragement of the exchange of information among
organizations. It promotes the development and dissemination of clinical
practice guidelines. The Academy has prepared clinical protocols for the care
of breastfeeding mothers and infants that are available on the Agency for
Healthcare Research and Quality's (AHRQ) National Guideline Clearinghouse
website.

Breastfeeding
Medicine is the official journal of the Academy of
Breastfeeding Medicine. It is an authoritative, peer-reviewed,
multidisciplinary journal published bi-monthly. The Journal publishes original
scientific papers, reviews, and case studies on a broad spectrum of topics in
lactation medicine. It presents evidence-based research advances and explores
the immediate and long-term outcomes of breastfeeding, including the
epidemiologic, physiologic, and psychological benefits of breastfeeding.